The SubSTance abuSe handbook # 151357   Cust: LWW   Au: Ruiz  Pg. No. i K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services # 151357   Cust: LWW   Au: Ruiz  Pg. No. ii K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services The SubSTance abuSe handbook Second ediTion Pedro Ruiz, M.d. Professor and Executive Vice-Chair Director of Clinical Programs Department of Psychiatry and Behavioral Sciences Miller School of Medicine, University of Miami Miami, Florida eric c. Strain, M.d. Professor Director, Johns Hopkins Center for Substance Abuse Treatment and Research Medical Director, Behavioral Pharmacology Research Unit Johns Hopkins University School of Medicine Baltimore, Maryland # 151357   Cust: LWW   Au: Ruiz  Pg. No. iii K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services Acquisitions Editor: Julie Goolsby Senior Product Development Editor: Kristina Oberle Production Project Manager: Bridgett Dougherty Senior Manufacturing Manager: Beth Welsh Design Coordinator: Holly McLaughlin Production Services: S4Carlisle Publishing Services © 2014 by Lippincott Williams & Wilkins, a Wolters Kluwer business Two Commerce Square 2001 Market Street Philadelphia, PA 19103 USA www.LWW.com 1st edition, © 2007 by Lippincott Williams & Wilkins All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilizing by any information storage and retrieval sys- tem without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Printed in China Library of Congress Cataloging-in-Publication Data The substance abuse handbook / editor, Pedro Ruiz, Eric C. Strain. — Second edition. p. ; cm. Companion to: Lowinson and Ruiz’s substance abuse : a comprehensive textbook / editors, Pedro Ruiz, Eric C. Strain. 5th ed. c2011. Includes bibliographical references and index. ISBN 978-1-4511-9196-7 (paperback) I. Ruiz, Pedro, 1936- II. Strain, Eric C. III. Lowinson and Ruiz’s substance abuse. [DNLM: 1. Substance-Related Disorders. 2. Behavior, Addictive. WM 270] RC564.15 616.86—dc23 2013044532 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this informa- tion in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recom- mended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice. The publisher has made every effort to trace copyright holders for borrowed material. If they have inadver- tently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Lippincott Williams & Wilkins cus- tomer service representatives are available from 8:30 am to 6:30 pm, EST, Monday through Friday, for telephone access. Visit Lippincott Williams & Wilkins on the Internet: http://www.lww.com. 10 9 8 7 6 5 4 3 2 1 # 151357   Cust: LWW   Au: Ruiz  Pg. No. iv K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services PReFace i n 2007, we conceived, created, and published the first edition of The Substance Abuse Handbook as a practical companion book to the fourth edition of Substance Abuse: A  Comprehensive Textbook, published by Lippincott Williams and Wilkins in 2005. At that time, it was clear to us that mental health professionals working in the field of addiction, pri- mary care practitioners, addiction counselors, students, residents, and trainees at large needed a clinically oriented handbook that focused on the most essential aspects of addictive disorders and their treatment. Our goals were very ambitious. In creating and publishing the first edi- tion of The Substance Abuse Handbook, we, together with Wolters Kluwer Health/Lippincott Williams and Wilkins, offered the field authoritative, clinically oriented information on the topic of substance use, abuse, and dependence, with an emphasis on diagnosis, treatment, and prevention. Our goal was to provide short and focused reviews on the nature of substance abuse as well as each type of drug that is abused, chapters that addressed comorbidities and other related disorders, and also information about treatment approaches. In addition, we also wanted to create a handbook that could be useful to all disciplines involved, directly or indi- rectly, in the addiction field. We were very pleased that the first edition of this Handbook was very well received throughout the field and by a wide variety of practitioners—reflecting, in part, the multidisci- plinary nature of those who treat persons with addictions. Over the ensuing years the addiction field has continued to change and evolve. At the present time, we are better able to under- stand the biological, psychological, behavioral, and sociocultural aspects of addictive disorders and conditions associated with substance use. New treatment approaches and different modes of intervention have continued to be tested, shown to be effective, and brought into clinical practice—helping people who suffer from addictive disorders. These advances in our under- standing of addictions, as well as new methods of intervention and treatment, have stimulated us to produce the second edition of The Substance Abuse Handbook as a practical and relevant companion to the fifth edition of Lowinson and Ruiz’s Substance Abuse: A Comprehensive Textbook, also published by Wolters Kluwer Health/Lippincott Williams and Wilkins in 2011. This second edition of The Substance Abuse Handbook follows the general outline and format of the latest edition of the Comprehensive Textbook, and addresses those topic areas that we thought were particularly useful in a more abbreviated version of that larger book. As is always the case, the interested reader should be aware that the field is constantly evolving, and that the current Handbook’s material should be balanced by familiarity with timely literature on the nature of addictive disorders and their treatment. That said, our hope is that this book will provide a useful resource that provides more condensed information about substance use disorders. Our target audience continues to be all who treat persons with substance abuse dis- order. We hope you will find this book a useful resource in your daily practice. v # 151357   Cust: LWW   Au: Ruiz  Pg. No. v K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services vi Preface Finally, we want to take this opportunity to thank and express our appreciation to the per- sons who assisted us and made possible the publication of the second edition of The Substance Abuse Handbook. We first thank the expert authors and colleagues who helped and collabo- rated with us in the production of the fifth edition of Lowinson and Ruiz’s Substance Abuse: A Comprehensive Textbook; second, we thank the editorial staff of Wolters Kluwer Health/ Lippincott Williams and Wilkins. Third, we recognize our staff who worked very hard in making this handbook a reality. Fourth, we show appreciation for our family members who supported us during this academic and clinical project: our spouses, Angela Ruiz and Grace Serafini, as well as our children and grandchildren. Finally, and most important, we extend our deepest gratitude to the patients who have suffered from addictive disorders and conditions; these patients stimulated us to work harder in this area of the medical field. They certainly de- serve the best outcomes of our efforts. Pedro Ruiz, M.D. Eric C. Strain, M.D. # 151357   Cust: LWW   Au: Ruiz  Pg. No. vi K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services conTenTS Preface v SECTION 1 • Etiologic Factors 1 1 Etiology 2 2 Epidemiology 14 3 Evaluation and Diagnosis 24 SECTION 2 • Substances of Abuse 35 4 Alcohol 36 5 Opioids 48 6 Cocaine and Crack 58 7 Cannabis 71 8 Amphetamines and Other Stimulants 82 9 Sedative–Hypnotics 92 10 Hallucinogens 102 vii # 151357   Cust: LWW   Au: Ruiz  Pg. No. vii K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services 11 PCP, MDMA, and Designer Drugs 112 12 Inhalants 118 13 Nicotine 129 14 Caffeine 139 15 Anabolic–Androgenic Steroids 150 SECTION 3 • Compulsive and Addictive Behaviors 161 16 Eating Disorders 162 17 Pathologic Gambling 172 18 Sexual Addiction 182 19 Internet Addiction 192 SECTION 4 • Treatment Modalities 203 20 Methadone Maintenance Treatment 204 21 Buprenorphine Treatment 215 22 Naltrexone and Other Pharmacotherapies for Opioid Dependence 225 23 Alcohol Abstinence Pharmacotherapy Treatment 234 24 Vaccines for Substance Use Disorders 244 25 Acupuncture 254 26 Nicotine Treatment 265 27 Psychosocial Treatments 276 28 The Therapeutic Community 293 29 Individual Psychotherapy 298 30 Group Therapy 306 viii # 151357   Cust: LWW   Au: Ruiz  Pg. No. viii K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services 31 Family/Couples Therapy 317 32 Cognitive–Behavioral Therapy 326 33 Contingency Management 336 34 Motivational Interviewing and Enhancement 343 35 Relapse Prevention 355 36 Management of Associated Medical Conditions 368 37 Medical Complications of Drug Use/Dependence 379 38 Psychiatric Complications of HIV-1 Infection and Drug Abuse 392 39 Acute and Chronic Pain 404 40 Psychiatric Comorbidity 415 41 Medication Interactions 424 42 Models of Prevention 435 43 Substance Abuse among Adolescents and the Elderly 450 44 Women and Addiction 461 45 Special Populations 475 46 Incarcerated Populations 492 47 Substance Use Disorders among Health-Care Professionals 500 48 The Homeless 508 49 Training and Education 515 50 Forensics 529 Index 541 ix # 151357   Cust: LWW   Au: Ruiz  Pg. No. ix K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services # 151357   Cust: LWW   Au: Ruiz  Pg. No. x K S4DcESIGaN SrERVlICiESS OlF e Title: The Substance Abuse Handbook 2e Short / Normal / Long Publishing Services